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Hospitals work to change the norm and eliminate preventable birth injuries through a new safety initiative

Posted
April 1, 2009

Preventable birth
injuries are rare. At the
University of Minnesota
Medical Center (UMMC),
they happen just
0.3 percent of the
time, or to about four
babies out of 2,700
deliveries each year.

“But even if you
only have 0.3 percent,
that’s still four babies
a year. And that’s
somebody’s baby,” says Becky Gams, R.N., M.S.,
C.N.P., clinical nurse leader and site coordinator
for the new Zero Birth Injury safety campaign at
the University’s hospital.

“There’s an economic cost, a liability cost,
[and] there’s a very personal cost—for everybody
involved,” says Philip Rauk, M.D., medical director
of the hospital’s Birthplace and also a UMMC site
coordinator for the initiative.

The multidisciplinary Zero Birth Injury effort
aims to render preventable birth injuries obsolete.
UMMC is one of six hospitals owned by Fairview
Health Services in the Twin Cities metro area that
is reevaluating best practices focused on three
aspects of delivery to enhance newborn safety:
induction, augmentation, and vacuum delivery.

In recent decades, Rauk says, birthing decisions
across the country were being made based on
concerns other than the health of the mother and
baby. Many inductions, for example, were done
primarily for the mother’s or the physician’s
convenience.

Now Fairview’s policy is not to perform elective
inductions before 39 weeks, thereby reducing the
chances of a lengthy labor and Caesarean section.
“And we improved on that by also saying [the
mother] should at least be ready to go into labor,”
Rauk says.

The way inductions are done also is changing
based on new science. For instance, giving patients
higher doses of pitocin, a medication intended
to hasten contractions, has become increasingly
common over the past couple of decades. But
higher does of pitocin have been associated with
contractions that were too close together, which
in turn were associated with birth injuries. Newer
science suggests that contractions that are too
close together affect the baby’s oxygen levels
sooner than previously understood, and now
health-care providers pay closer attention to
contraction frequency.

So far compliance with the new safety
standards is high at most participating hospitals,
but it’s too early to discern whether or how that’s
affecting outcomes, Gams says. She and Rauk
expect to see definitive changes in outcomes by
early 2010.

Ultimately, most health-care professionals and
patients appreciate the need to put science and
safety ahead of expedience, Rauk says.

“We’re taking evidence-based medicine out of
the journal article and bringing it to the bedside,”
he says.